Multiple neurohumoral modulating agents in systolic dysfunction heart failure: are we lowering blood pressure too much?

Journal of Cardiac Failure
George MakKenneth McDonald

Abstract

Disease-modifying drug treatment in heart failure (HF) reduces blood pressure. Titration of these agents is guided by clinic blood pressure readings; however, the impact of such treatment on blood pressure is unknown because diurnal blood pressure patterns remain poorly described. The aim of this study was to examine the impact of additional neurohumoral modulating agents on ambulatory blood pressure monitoring (ABPM) control in patients with systolic HF and examine the relationship between the burden of hypotension and clinical outcomes. In a prospective analysis on 45 patients undergoing initiation and optimization of additional medications (angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, or beta-blockers), mean daytime systolic (P = .035) and mean daytime and nocturnal diastolic hypotensive episodes (both P < .001) increased significantly posttitration. There was no change in clinic blood pressure before and after titration. In a cross-sectional analysis on 144 patients, those with the most diastolic hypotensive episodes had higher rates of HF readmissions (P = .01) and the composite end point of all-cause mortality and all-cause readmissions (P = .03). Additional neurohumoral modulating agents co...Continue Reading

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Citations

Jun 26, 2014·European Journal of Heart Failure·Michel KomajdaUNKNOWN SHIFT Investigators
Sep 24, 2015·The Canadian Journal of Cardiology·Jonathan G HowlettUNKNOWN Canadian Cardiovascular Society Heart Failure Guidelines Panels
Jul 28, 2016·Journal of the American Society of Hypertension : JASH·Juan A Divisón-GarroteLuis M Ruilope
Jul 23, 2015·Circulation. Heart Failure·Muthiah VaduganathanMihai Gheorghiade
Nov 18, 2018·Clinical Trials : Journal of the Society for Clinical Trials·Fred YangBertram Pitt
Nov 20, 2012·European Journal of Heart Failure·Bertram Pitt
May 14, 2020·Hypertension Research : Official Journal of the Japanese Society of Hypertension·Juan A Divisón-GarroteJosé R Banegas
Apr 22, 2009·Expert Review of Cardiovascular Therapy·Saraswathy ManickavasagamAlejandro Barbagelata

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